LOOKING INTO THE TOOTH... I MEAN TRUTH!

After five long years of not going to the dentist, my friend Natalie finally made an appointment. In her mind her teeth were turning colors and she thought she had a cavity so she was nervous. No one likes going to the dentist, especially after falling off the “bandwagon”, there is always the expectation of bad news. By advising her on what to expect, I tried to calm her nerves.

Well, her expectations had been met and more. I had already prepared for her for the chance of being diagnosed for multiple cleaning appointments. Five years is a long time to go without. I had already prepared her for the doctor exam and x-rays the office would need to responsibly suggest treatment. I had already prepared her for what the insurance would most likely cover.

What we weren’t prepared for was the bill for optional localized antibiotic treatment exceeding $300.00. Everything seemed pretty kosher until this last element. First off, localized antibiotics are great in select instances and are used in help reform disease. It’s not a cure. The cost is about $30 – $40 a site. Secondly, if you have such a generalized problem, requiring over ten sites of antibiotic delivery, a referral to the periodontist should probably be made. She had been taken advantage of.

I asked her if she remembered her probing or pocket depths (this is where the hygienist measures the gums and calls out numbers to help determine treatment) and she thought she had two 5mm sites and a few 4mm sites (1-3 mm is normal, higher numbers indicate gum problems) . I think most dental professionals would agree Natalie had been scammed.

None the less, Natalie did not return to that office. A year later, it was time to try out a new office. Learning a great deal from the last experience, she was confident and fearless going forward. When I inquired about the new office, she said it was fine but her face said otherwise. Getting her to share this experience was like “pulling teeth.” It turns out this last cleaning consisted of a rubber cup and some paste, that’s it. The whole appointment lasted approximately 10 minutes. No instruments, no measurements, no doctor.

I just felt awful, poor girl can’t catch a break and I know she is not the only one who has had to deal with this confusion. The last cleaning consisted of four appointments and an “aggressive” amount of localized antibiotic and then her next go at it turns out to be an cleaning sufficient for a toddler. Either way, she did not receive fair treatment financially or procedurally.

I hate when this happens to my friends, so below is brief guide to the different types of procedures hygienists do, what they basically entail and what you can expect:

PROPHY (basic cleaning)

• Indicated when patient presents with a relatively healthy mouth
• Minimal bleeding and inflammation
• Pocket depths range from 1-3 mm, probing done once a year
• Removal of stain, soft and hard deposits above the gumline to 1mm below

PROPHY ONE AND TWO

• May be indicated when a patient presents with relatively healthy gums and measurements, but displays poor hygiene or is severely overdue
• Two appointments are needed dividing the mouth into right side and left side or gross scale and fine scale appointments
• Polish after whole mouth has been completed
• Anesthetic used at the discretion of the dental professional

GROSS DEBRIDEMENT

• Removal of stain, soft and hard deposits above the gumline to 1mm below to alleviate some inflammation prior to scaling and root planing appointments

SCALING and ROOT PLANING (quads, therapies, SRPs)

• May be indicated when a patient presents with gingivitis, deep pocket depths exceeding 4-5mm, neglected hygiene, sub and supragingival deposits
• Multiple appointments are needed
• Anesthetic is used for the comfort of patients
• Localized antibiotic may be administered at the discretion of the dental professional
• Automatic 1-3 month recall after whole mouth is completed for re-eval

PERIO RE-EVAL

• 1-3 months after the completion of scaling and root planning
• Full mouth probing or measurements is documented to determine health status, evaluate patient compliance, if an area needs to be readdressed or localized antibiotic could be beneficial
• Removal of stain, soft and hard deposits to the base of the pockets if possible
• Polish
• Recall is every 3 months unless stated by the dental professional

PERIO-MAINTENANCE

• Indicated when patient presents a history of scaling and root planing or other periodontal issues
• Removal of stain, soft and hard deposits to the base of the pockets if possible
• Assess need for localized antibiotic if beneficial
• Polish and floss
• Recall is every 3 months unless stated by the dental professional